Open bite & TMJ...considering braces/surgery

[jboston]

Hey everyone, new to the board and hoping to get some advice.

I am 27 years old male and have had TMJ/muscular pain issues ever since might be bite turned into an open bite when I was 19 (for unknown reasons). For those first couple years I had localized pain and classic TMJ symptoms (clicking/popping, tension headaches, ringing in the ears, etc.) but overtime my symptoms progressed as I started developing neck/back and other musculoskeletal chronic pain issues. I have had bruxism ever since I became of my open bite (unclear which came first - the grinding or TMJ/bite change) and my #1 symptom has always been muscular pain and headaches. I have tried different mouth guards at night but none have ever seen to alleviate the symptoms in any truly significant way and as such I've just learned to live with it.

I have received a diverse set of opinions over the years with some dentists adamant that I need address the bite issue if I want to start feeling somewhat like my old self again. At one point, right after this all started, I tried braces but after several months and no major improvement I stopped treatment after seeing a pain center in Boston that recommended trying other conservative approaches first as they made it clear that fixing the bite wouldn't necessarily help the symptoms (and as 20 year old college student I was happy to give up wearing braces assuming they MIGHT not help after all). However, overall my symptoms have only gotten worse over the years and so I am now more seriously considering aggressive treatment like braces/surgery in order to correct the bite (I only hit on my back molars). I wouldn't expect it to "cure" everything but over the past year or so I've had more difficulty speaking and feel that every I'm constantly trying to compensate for a bite that my brain has never gotten used to.

I went years focused on managing the symptoms and not looking into ways to address the bite issue but feel that I can't keep pushing this off forever (many dentists I have seen would agree).

So I'm curious if anyone has dealt with similar issues and if anyone has any recommendations for me.

Thanks in advance.

[GreyViolets]

Prior to my second round of braces for a posterior open bite, my first ortho messed up everything. I developed facial pain, TMJ issues, flat cheekbones - you name it.

I went to a TMJ specialist who gave me a splint to allow my jaws to heal, then had my second round of braces. I can breathe better now, and my arches have expanded, and I'm getting surgery in December.

Since you have TMJ problems (and most orthos just know how to retract.) I would recommend seeing a TMJ specialist who focuses on improve the bite, position of the jaws, and overall profile.

Choose someone who focuses on improving your FACE, not just the teeth.

[jboston]

[quote="GreyViolets"]Prior to my second round of braces for a posterior open bite, my first ortho messed up everything. I developed facial pain, TMJ issues, flat cheekbones - you name it.

I went to a TMJ specialist who gave me a splint to allow my jaws to heal, then had my second round of braces. I can breathe better now, and my arches have expanded, and I'm getting surgery in December.

Since you have TMJ problems (and most orthos just know how to retract.) I would recommend seeing a TMJ specialist who focuses on improve the bite, position of the jaws, and overall profile.

Choose someone who focuses on improving your FACE, not just the teeth.[/quote]

Thanks for the reply. I too have developed significantly flat/weakened cheekbones as well as breathing problems. I've had a couple specialists tell me to do the same thing you're doing new "anterior stabilization" splint and then reevaluate re: ortho/surgery while others say I should start ortho immediately in conjunction with surgery. I'm leaning towards the latter just because I'm not getting any younger and it's not clear to me if a new splint is worth the wait.

How long did you wear the splint before starting ortho? Also, do you wear any kind of splint / mouth guard for sleep during ortho treatment?

[GreyViolets]

Thanks for the reply. I too have developed significantly flat/weakened cheekbones as well as breathing problems. I've had a couple specialists tell me to do the same thing you're doing new "anterior stabilization" splint and then reevaluate re: ortho/surgery while others say I should start ortho immediately in conjunction with surgery. I'm leaning towards the latter just because I'm not getting any younger and it's not clear to me if a new splint is worth the wait.

How long did you wear the splint before starting ortho? Also, do you wear any kind of splint / mouth guard for sleep during ortho treatment?

I am really sorry to hear about your breathing problems and know how difficult it can be. Sometimes, in terms of treatment, it's hard to decide what the best course of action would be, so it would be best to asses the pros/cons of each.

Pros of splint first + braces + jaw surgery

1. It allows your jaws joints to heal
2. It allows some time for your jaws to rest in a more comfortable position
3. Usually, the splint will relieve a lot of pain, but the real of braces for more stable and permanent relief/work would have to be from a TMJ specialist as he/she will used braces and work with your oral surgeon.


Cons of splint therapy first

1. It can be bulky to wear
2. Overall treatment takes more time. (It can be worth it, at least it was for me.)
3. If the splint is too thick, it might take up too much room on the roof of your mouth.

I wore the splint day and night (wore it more diligently at night.) for about six months prior to ortho work, but every case is different. I was battling suicidal depression and pain nearly everyday. I no longer have facial pain since he's moved everything forward and my cheeks and mouth are more prominent and defined.

when you visit a TMJ specialist, I highly recommend expressing your concerns like not being able to breathe properly. Do you also have a lack of tongue space in your mouth? The proper resting position/oral posture for the tongue is to keep it on the roof of the mouth. If your tongue rests low in the mouth and find it generally uncomfortable to keep your tongue on your palate, you must also mention this.

I don't wear any mouth pieces as of now since starting my braces. Sometimes oral/functional appliances can be used in conjunction with braces and preparing for jaw surgery.

[plocon]

Jboston! I've tried searching EVERYWHERE on the internet for find someone who is in the same situation as me. You are exactly me, but I'm younger 23 years old, I developed this problem 2 years ago and only the back molars touch my teeth causing an open bite. To me you are valuable and I'm am valuable to you. I can tell you what I tried and what helped me, and what I am going to do. If your MRI shows that everything is fine, consider finding a doctor who will give you a drug called "klonopin". ALL my symptoms go away when I drink this drug, but NOT SO FAST... it only treats the symptoms but not the problem. I stopped taking this drug to see if the symptoms come back and it did after 3 days! This leads me to believe that it had something to with the way my muscles are interacting with my teeth. I'm getting braces soon to fix this open bite and you should too! Please let's stay in touch, you're very valuable to me because you are describing the same bite, the same symptoms! If one of us finds a cure, we can tell each other!

[jboston]

@plocon - the similarities are striking! Sorry for the delay here...I'm guessing you've had the braces put on so how's that going??

[plocon]

[quote=jboston post_id=498959 time=1512082844 user_id=30423]
@plocon - the similarities are striking! Sorry for the delay here...I'm guessing you've had the braces put on so how's that going??
[/quote]

Sorry for the delay too, I'm always busy in college and currently a senior in my major electrical engineering (extremely tough stuff!). And yup I got the braces! So far I still have an open bite. I assume my brain keeps telling my brain that it's extremely uncomfortable where my teeth are so my muscles (primarily on the temporalis) is being overworked. But my bite is changing and I can already tell it's starting to close, hopefully when it closes I won't have this 24/7 constant pain. I hope you're doing well. I've had braces for about 7-8 months and need about 6-8 months to go. This is such a slow process, when I finish my braces I'll tell you if braces worked for me. Good luck!

[LockedinMyTower]

Definitely curious how your bite is progressing. I’m also in my 20s, had braces as a kid, and I didn’t have an open bite before treatment. But I was diagnosed with oral lichen planus in 2012, which is an autoimmune disease that affects mucus membranes, and my mouth went HAYWIRE. I had so much pain, I could barely eat. The inside of my cheeks peeled, my gums were suddenly inflamed, and my tongue was on fire.

At the suggestion of an oral surgeon in Boston, he suggested I refrain from wearing my retainers to see if I was having a reaction to them or not. My teeth shifted drastically, and so fast! And now I have an open bite. Lichen planus does not go away, but now I have oral medication to help with pain and medicated mouthrinses to keep it in check.

I started back with my original orthodontist, and started with having him make me a bottom Essix retainer (plastic and acrylic) like I had when my braces came off, to fix a crooked bottom tooth. I really wanted to see if my lichen planus would react. No reaction to the retainer itself, but to the blue material used to make the mold, So, then he said, well, let’s do a removable palate expander. I was game. My front teeth, which were sticking out quite a bit, have come in, my open bite slightly, and now I’m at the point that I need braces. Unfortunately, due to life and my house being upside down, I finally made it back to the orthodontist to book a consult appointment.

So happy to read you're seeing progress! I’m assuming you’re in elastics, too? Thanks in advance.